Sunday, August 16, 2009

So you've probably seen by now that Whole Foods CEO John Mackey has publicly come out against health care reform. This does not seem to be an exceptionally bright move for a company with a liberal customer base, and we're starting to see a backlash. In fact, people are using Whole Foods' own web forums to call for a boycott! Is this really a reason to boycott a company, though? I would say no. The company overall seems to be somewhat sympathetic to liberal causes, and certainly treats its employees well (though, like Wal-Mart, they are vehemently anti-union). One guy spouting off isn't enough to make me want to participate in a boycott. If you're going to stop shopping at Whole Foods, do it for the right reason: because it's too damned expensive.

25 comments:

I agree. (Although, honestly, I rarely shop there anyway. I'm more of a Costco liberal.) We should avoid boycotts except when it really makes sense... Boycotting at the drop of a hat waters down the tactic and makes it seem silly.

Also, I believe the Obama administration has been fairly careful to avoid demonizing anyone in this debate, because he wants all the major stakeholders to be involved, including Big Pharma, the ABA, and health insurance companies. It would be easy to demonize any of them to advance the cause of reform.

They don't call it Whole Paycheck for nothing...the fact that the CEO came out against health care reform and the fact that Whole Foods is HQ'ed in Texas, where the biggest part of the anti-health care reform comes from in my opinion, the prices, their massively inconsistent supply chain...all good reasons to boycott. WW

I didn't need another reason to avoid Whole Foods, but now I have one. I note that the head of WF talks about "individual empowerment" as the solution to health care problems. He then says, amazingly, "Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices."

This is appalling Puritanical nonsense. As more than one person has pointed out, half of all heart disease appears to be unrelated to cholesterol or obesity, and the only cancer that seems to be "preventable" is lung cancer - or rather, those lung cancers caused by smoking. Juvenile onset diabetes ("type one") accounts for 5-10% of all diabetes. The idea that we should blame all our health care costs on fat people and smokers is absurd, dangerous nonsense. By the way, did anybody notice the math: he says that two thirds of all Americans are overweight, and that diseases caused by being overweight are responsible for 70% of health care costs. Wow. I'm blown away.

The truth is that the most expensive diseases, most cancer, alzheimers, etc., those that require long and intensive treatment, seem to strike at random.

I'm sorry if you have bought into the organic-new-age advertising, but here's the rub: (1) eating so-called healthy foods (variously defined, but usually things that aren't too tasty) will not make you immune from cancer, ALS, Alzheimers, parkinsons, and other terrible diseases; (2) those who suffer from these diseases should not be blamed for their misfortunes; (3) the link between obesity, poor heath, and poverty is not unrelated to the lack of health insurance.

Mackey's nonsense is also another example of proposing indvidual solutions to collective-action problems, to avoid having to make the systemic changes necessary to address the real problem: some redistribution of income is going to be necessary in order to provide adequate health insurance to all.

..Right on LTG...and another thing this asshole doesn't mention...most health care issues, disease and illness are caused by the environment and how corporate America has polluted 2/3 of our rivers, dumped tons of cancer causing toxins into the air, SUVs and the biggest of all, raising farm animals for slaughter...simple for him to overlook I guess. There is no question that our eating habits could be improved, but they are clearly not the cause of all our health concerns. I would like to ask this asshole why most people, when they die of heart attacks, die on Monday morning...it is because of the stress of a job...he is just another ignorant ass from Texas spouting off...and I can say that, I'm from Texas too.

LTG: whilst you're right to say that people suffering from diseases shouldn't be blamed for their misfortunes (if nothing else, the average Joe on the street can't tell who's lived how, so making blaming ok just leads to random abuse), and that healthy foods will not make you immune from these diseases, there are quite a few studies out there that show that eating healthily, as well as not smoking, not drinking excessively, getting some decent exercise/living a more active life (e.g. cycling/walking to go short distances), significantly lower individual risk factors for diabetes, heart disease, Alzheimers, various cancers etc etc, all of which are conditions that obesity/being overweight/sedentary lifestyles increase individual risk factors for (other things can also increase these factors, such as the ones WW lists).

These diseases aren't called "lifestyle diseases" for nothing! And yes, genetics has a big part to play in deciding your baseline risk factor, but your personal decisions through your life can massively up that risk. So, unfortunately, that quote of his that you describe as "appalling Puritanical nonsense" does actually have some basis in fact, even if he's presented it badly/twisted it a bit.

Which isn't to say some "ignorant ass from Texas" should be allowed to spout off saying that health care reform isn't needed - it clearly is.

Ideal world: health care reform so that absolutely everyone is covered (regardless of pre-existing conditions etc), and a general societal shift in thinking with everyone wanting a healthier lifestyle for themselves and their kids, which would include healthy foods such as whole pieces of fruit not being more expensive than a big bag of over-processed crap (this would not involve abusing those who you think aren't doing the right thing, but would simply be taking responsibility for your own body as far as you can. Random genetics obviously you just have to live with. And yes, over-processed crap can be good at times, but when you're poor and it's all you can afford to eat *all* of the time, that ain't good - there's another poverty-poor health link).

An anecdote: This morning at a service store I listened to a self-described artist (a thin but otherwise not very attractive 30-something white woman in sweats with paint on them) harangue a seriously overweight African-American woman (the cashier who was thankfully -- for the artist -- behind a plate glass window) about how she could lose weight easily if she just ate vegetables. "I eat tons of food", she said, "but it's all good food!" And she made some comment about flaxseed that I couldn't decipher. Then this self-appointed lecturer concluded by saying that there were "over 70 genetically modified vegetables on the market" even though "vegetables were fine just as God made them naturally." She actually bubbled along as she said these things and referred to her as "girlfriend," as if this was a conversation they were both enjoying. Afterward, the African-American lady shrugged her shoulders and turned to me.

Mr. Mackey's comments struck me as of the same ilk. Not just the overclaiming and the pseudoscience, but the issues of race and class just below the surface.

Calling them "lifestyle diseases" is just marketing for dubious claims.

Like it or not, one of the biggest predictors of heart disease is gender. Even accounting for other factors (nutrition, diet, age, overall health), men die of heart disease much more frequently than women.

Ethnicity also plays a big role in whether you develop conditions like insulin-dependent diabetes.

When I was pregnant, I heard all sorts of nonsense about how breastfeeding was the fast track to perfect health and every forkful of food I put in my mouth was a life-or-death decision. Thankfully, my doctor was much more sanguine and never once harassed me about my (normal) weight gain.

I take Law Talking Baby to the odd fast-food joint, while it's common to see other kids there, they are usually not upper-middle class types. But for $20, these kids get a clean playground and a happy family meal. Who am I to say these parents are making a bad decision?

Another anecdote: I've gone part-time vego over the last year or so, in that on the vast majority of days (certainly all weekdays, and plenty of weekends too), I only eat meat at dinnertime - breakfast is yoghurt/cereal/toast/pancakes/eggs, with the odd weekend breakfast involving bacon (you're never taking away my bacon!); lunch is something like an Indian veggie/lentil dish, some white risotto (+pesto maybe), some pasta, a salad or some soup; dinner involves meat most days (I'm trying to be totally vegetarian at least one day a week. Vegan is never happening, as you're also never taking away my cheese!). I've lost about six kilos (12-13 pounds), off a frame that wasn't exactly overweight to start with - the start point was how I looked at Dr.S' wedding (and the weight loss was unintentional, I only know my weight because I had a visa medical last year and then a work medical recently. And my clothes are too big, which is irritating). So, I'm in agreement with a general point that eating mostly veggies / cutting down on meat would probably result in weight loss for a lot of people.

I also have various issues with GM veg/seeds/foods, although they're not due to a terror of eating "things with genes in", they're to do with two basic points - the selfish one is that I find true heirloom veg, picked when properly ripe and eaten soon, to be vastly superior to supermarket bought stuff in terms of how good it is to eat (and cook with of course); the other is that the behaviours of companies such as Monsanto, for example patenting seeds and suing farmers for saving seeds for next year / developing suicide hybrids which cannot be used for seed saving, strike me as deeply unethical.

However, self-appointed lecturing, talking about personal experiences as science (I'm not definitively claiming that eating my way will guarantee weight loss, nor that it's an absolutely healthy way of eating, nor that it's the only way to lose weight and/or eat healthier), and pandering to these race and class issues - nope, not for me thank you very much!

Problem is, there's quite clearly plenty of people who either agree with the racial/class subtext, or are willing to turn a blind eye. For example the anecdote you relate - you don't mention the reactions of everyone in earshot, but it doesn't sound like anyone bothered sticking up for the cashier, telling the artist to wind her head in and stop being offensive - I'm going to guess that no-one wanted to deal with it.

When it comes down to it, there's a high probability that that cashier is not as healthy as she could be if she was slimmer (there are of course plenty of somewhat overweight people who are healthy, mobile, etc but you've described the cashier as seriously overweight, which doesn't sound like she fits that description. Only she and her doctor really know though. Assuming she has a doctor!). But that doesn't give anyone the right to label her, much less abuse her and/or blame her, especially in that kind of way.

Let's assume the food thing is right. Let's assume that Mackey is on to something with this 2/3 of people are overweight and they account for 70% of the health care costs (probably both estimates and quite possibly estimates of the same number! as LTG pointed out). But let's assume he's right and we use "individual empowerment" or whatever to fix it.

Eating all the right things - even transforming yourself into a macro-biotic-vegan-organic-fanatic-with-a-jogging-fetish won't make you immortal. It will only change what you die of. Instead of getting a heart attack at 73 you'll get something else at 80.

Ironically, longevity also expands other costs. While health care costs go down in the short term (but not in the long term, if people die anyway with expensive complications later) with a healthy 85 year old, pension and social security costs go way up.

I was the only person around and the cashier seemed quite unflapped by it all. Presumably she is used to lectures by white people for various reasons. When my turn came up, I smiled at her and said, "You must get a lot of nonsense on this job." She then broke into a big, beautiful smile and said, "Lord, you don't know the half of it."

I sat next to a man on an airplane last month who spent the entire time telling me about how eating certain plants in tea form will cure all disease, including cancer. He and others had had some vision from God while in Mexico. Now, I'm not one to pooh-pooh visions - I suspect that powerful spiritual experience can sometimes be the outward accidents of genuine insight and self-realization. But he looked rather ill, so I was skeptical about his health claims. And he wouldn't shut up. I had two choices: make a scene as more hot-blooded folks may have done, or try to find some way to frostily disengage as those of us of Northern European cultural heritage have long practiced. I chose the latter course.

Truth is, the African-American lady behind the service counter didn't need a lecture. I suspect she lives in an area of town where you don't go jogging or walking alone, especially not after dark. And there are no gyms nearby she could join, even if she could afford one. And her schedule is likely irregular and combined with the stress of taking care of kids and possibly an elderly relative. No health insurance or doctor either, I'd wager. And there is probably no grocery store at all near where she lives, just the "corner groceries" with higher prices, and run by Korean-Americans with whom there is a longstanding animosity, causing more stress. All of these things conspire to make regular exercise or a healthier diet harder. Plus, she has no time. McDonald's, at least, provides some relaxation and satisfaction in an otherwise difficult day. The solution for this woman is not to make her feel guilty about the pleasure and convenience of fast or processed foods, but to improve her economic condition and that of her neighborhood.

...or if we take RBR's opinion that health care cost are a function of mortality, then it is the health care community and the nutrition industry who are to blame for the cost of health care and the crisis. If we are expected to live to age 75, and if most health care cost are then incurred in the last 10 to 15 years of life, then they are responsible for our rising cost. We weren't designed to last as long as we do now, mostly due to civilization, medical technology and nutrition. If not for nuclear medicine, MRIs, new surgery techniques, artificial heart valves, kidney dialysis, EPO, new, sexy drugs that keep one living 10 years longer than you would have...all of it, the health industry complex, drug companies, Whole foods are all responsible for us living longer, so they are in fact responsible for health care cost in the US. WW

What increases health costs is not living longer but dying slower. In other words, things like improved nutrition, preventive care, and surgeries that restore health and mobility are not actually a big financial drain: most of the cost comes from medical procedures that do not improve health but merely retard its rate of deterioration. Restoring health and forestalling death are not the same thing.

Although it always amuses me to see newspapers proclaim that good medical care lowers the mortality rate. Because people are living longer, the percentage of those who die on any given day is gradually falling... But of course the underlying death rate is still the same: 100%.

For longevity to be cheap, we would posit a healthy individual with few or no medical costs dying quickly in their 90s. If so, that is true. If what happens is a series of increasingly expensive medical treatmeents (such as hip replacements, etc.) prolonged over 20 years rather than 10 years even for a "healthy" person, then longevity is more expensive. And, of course, longevity certainly causes social security costs to rise also.

Longevity also has weird effects on wealth overall in the economy. Fifty years ago, most wealth was passed down from parents to children when the children were in early middle age, say their 30s or even 20s. Now we increasingly see a larger and larger percentage of the nation's wealth being passed down from 90-year-olds to 60-year-olds and not being available to younger generations for things such as starting businesses, downpayments on houses, or education.

Of course, I'm all for longevity, but we should not pretend that longevity is without its costs.

I want to emphasize that I don't think younger generations should be relying on an expectation of inheritance, but shifting inheritance patterns are still an economic fact with observable consequences.

"So you are under the opinion that open heart surgeries, hip replacements etc., that "restore" health, are not expensive and are no a drain on the system???"

WW: I agree those surgeries are expensive and they are a drain on the system. Hip replacements are happening a lot more often, for example, and that does matter. They are just not the biggest drivers of the increase in health care costs.

The Congressional Budget Office has an interesting study on this. They concluded that technology, not longevity, is the biggest driver of health care costs. Here are some snippets to that effect.

"Although elderly people generally incur higher costs for health care than younger people and much of the spending on health care goes toward the elderly, the contribution of an aging population to the growth in that spending over the long term is smaller than is commonly perceived... Increased longevity raises average per capita spending, but that effect appears to be modest.

"CBO concludes that roughly half of the increase in health care spending during the past several decades was associated with the expanded capabilities of medicine brought about by technological advances... New curative therapies with one-time costs could reduce spending if they obviated the need for costlier treatments... [but] many of the most notable medical advances in recent decades involve ongoing treatments for the management of chronic conditions such as diabetes and coronary artery disease... Improved survival among patients with end-stage renal disease, for example, has meant that more individuals are undergoing dialysis therapy for longer periods."

You know what... I've been thinking about the longevity issue LTG raised regarding the CBO study... and I think LTG and WW are right. I was wrong to blame the "death prolonging" medical treatments. What the CBO study actually shows is that the huge growth in health care spending is not due so much to the gradual increase in the life expectancy of the majority of folks--i.e., extending the lives of those who die of common conditions--but rather the growth is more due to inventing new (and costly) ways to treat the minority of folks who would otherwise have died young, of uncommon conditions. In other words, the main effect has been to reduce the youthful tail of the mortality curve rather than to shift it upward. That is why longevity per se is not the issue.

It's interesting looking at developing nations actually, and how the leading causes of death are changing in them. Diseases that commonly fall into the "lifestyle diseases" group, cancers and etc are on the rise, as those that no longer kill in great numbers in Western nations, such as malaria, are falling. Hard to tell straight off if it's simply that the populations are now living long enough to get these diseases, or if they've undergone other lifestyle changes that could be causing them too.

you know, I actually think going to the doctor shortens life spans. It seems everyone I know that goes to the doctor, gets loads of pills and seem to get sicker and sicker...I think that is what the health care companies want, keep us sick ad dependent on their pills. "Do you wake up in the morning and go to bed at night?"...then you need this pill!